Method of and apparatus for viewing the interior of the bladder through a suprapubic incision

ABSTRACT

A method of and an instrument for locating a suprapubic incision into the bladder and for inserting a viewing unit through the incision into the bladder. A telescope for viewing the interior of the bladder is insertable thereinto through the viewing unit. The viewing unit may be left in place for later viewing of the interior of the bladder therethrough, and may be sutured to the abdominal wall. Also, a retention catheter may be inserted into the bladder through the viewing unit. The insertion instrument is elongated and terminates in a curved distal portion insertable through the urethra into the bladder to bring the distal end of the instrument into engagement with the anterior wall of the bladder in register with the suprapubic area of the abdominal wall. The instrument is provided with a longitudinal passage therethrough from its proximal end to a point adjacent but spaced from its distal end, and has a lateral opening therein at the distal end of the passage. With the distal end of the instrument in engagement with the anterior wall of the bladder, the bladder is inflated with a suitable fluid through the passage and the lateral opening in the instrument. Then, the aforementioned incision is made through the abdominal wall and the anterior wall of the bladder in register with the distal end of the instrument. The distal end of the viewing unit is then connected to the distal end of the insertion instrument, and the distal ends of these devices are then inserted into the bladder through the incision. Subsequently, the distal end of the viewing unit within the bladder, and the insertion instrument is then withdrawn through the urethra, leaving the viewing unit in place for insertion of a telescope therethrough for viewing the interior of the bladder.

United States Patent Robertson 1151 3,656,485 [451 Apr. 18, 1972 [72]Inventor: Jack R. Robertson, 1451 Refugio Road,

' Santa Ynez, Calif. 93460 [22] Filed: Apr. 27, 1970 [21] Appl. No.:32,028

[52] US. Cl. ..l28/349 R, 128/8, 128/305 [51] Int. Cl. ..A6lm 25/00 [58]Field of Search l28/3-8, 303, 305,

128/311, 328, 341, 343', 348, 349 R, 349 B, 349 BV, 350 R, 350 V, 351,347

[56] References Cited I UNITED STATES PATENTS 2,256,942 9/1941 Duffy..l28/350 R 2,583,937 1/1952 Fossati ..l28/4 3,402,710 9/1968Paleschuck. 128/348 X 3,137,298 6/1964 Glassman ..l28/328 3,467,1029/1969 Fogarty et a1 ..128/348 FOREIGN PATENTS OR APPLICATIONS 126,8446/1918 Great Britain ..l28/7 1,102,994 2/1968 Great Britain ..l28/3471,161,436 8/1969 Great Britain ..l28/348 Primary Examiner-Dalton L.Truluck AI!0rne \'HarriS, Kiech, Russell & Kern [5 7] ABSTRACT A methodof and an instrument for locating a suprapubic incision into the bladderand for inserting a viewing unit through the incision into the bladder.A telescope for viewing the interior of the bladder is insertablethereinto through the viewing unit. The viewing unit may be left inplace for later viewing of the interior of the bladder therethrough. andmay be sutured to the abdominal wall. Also, a retention catheter may beinserted into the bladder through the viewing unit.

The insertion instrument is elongated and terminates in a curved distalportion insertable through the urethra into the bladder to bring thedistal end of the instrument into engagement with the anterior wall ofthe bladder in register with the suprapubic area of the abdominal wall.The instrument is provided with a longitudinal passage therethrough fromits proximal end to a point adjacent but spaced from its distal end, andhas a lateral opening therein at the distal end of the passage With thedistal end of the instrument in engagement with the anterior wall of thebladder, the bladder is inflated with a suitable fluid through thepassage and the lateral opening in the instrument. Then, theaforementioned incision is made through the abdominal wall and theanterior wall of the bladder in register with the distal end of theinstrument. The distal end of the viewing unit is then connected to thedistal end of the insertion instrument, and the distal ends of thesedevices are then inserted into the bladder through the incision.Subsequently, the distal end of the viewing unit within the bladder, andthe insertion instrument is then withdrawn through the urethra, leavingthe viewing unit in place for insertion of a telescope therethrough forviewing the interior of the bladder.

6 Claims, 15 Drawing Figures .PATENTEDAPR 18 I972 3, 6 56 4,85

- SHEET 1 0F 2 INVENTOI? JA CK R. Roaeersom BY ///5 A rmeusys #4226,M501, P055541. & Kseu CROSS REFERENCE TO RELATED APPLICATIONS Thisapplication is related to my copending applications Ser. No. 297, filedJan. 2, 1970, and Ser. No. 26,727, filed Apr. 8, 1970, and directed to amethod of and an instrument for inserting a suprapubic catheter. Sincethe present application and the copending applications mentioned havevarious features in common, the disclosures of the copendingapplications are incorporated herein by reference.

BACKGROUND OF THE INVENTION The present invention relates in general toviewing the interior of a body cavity, and particularly the interior ofthe bladder. The term viewing, as used herein, refers not only to directvisual observation, but to photographing the interior of the bladder ifa permanent record is desired.

Conventionally, the interior of the bladder is viewed through acystoscope inserted through the urethra into the bladder. Such aninstrument is of limited utility since it cannot be used for repeatedobservations without causing excessive urethral trauma, it cannot beused to view the interior of the bladder while it is functioningnormally, and the like.

SUMMARY AND OBJECTS OF INVENTION Generally speaking, the primary objectof the present invention is to provide a method of and an apparatus forviewing the interior of the bladder which involves viewing through anextraperitoneal suprapubic incision in the anterior wall of the bladderand the overlying abdominal wall.

More particularly, an important object of the invention is to provide aviewing or window unit which is insertable into the bladder through thesuprapubic incision and which is of a size to permit insertion of arelatively large conventional telescope therethrough into the bladder.

The foregoing general technique, utilizing a window of the natureindicated, has important advantages. First of all, it permits repeatedobservations of the interior of the bladder without trauma to theurethra. Such repeated observations may be desirable or necessary in thetreatment of various conditions, such as a bladder tumor, for example,following bladder surgery, and the like.

Secondly, the present invention permits observation of the interior ofthe bladder while the bladder is functioning substantially normally.Thus, not only can the physician observe the flow of urine into thebladder from the ureters, but he can also observe the functioning of theurethrovesical junction under substantially normal conditions. This isparticularly important to determine whether sutures have been placedproperly in surgery to tighten the urethrovesical junction in thetreatment of stress incontinence. Also, the physician can observe theaction of the bladder while taking a cystometogram, which is animportant feature.

These and various other significant advantages are attributableto thegeneral viewing technique and window unit of the invention.

Considering the invention more specifically now, another object thereofis to provide such a tubular viewing unit having at its proximal end aflange, preferably an annular flange, which seats against the exteriorof the abdominal wall to limit insertion.

A further object is to provide the flange at the proximal end of thetubular viewing unit with openings by means of which the unit may besutured to the abdominal wall if it is to be left in place for repeatedviewing of the interior of the bladder. If 70 the viewing unit is to beleft in place, and the use of a catheter is indicated, a suitableretention catheter, such as a Foley catheter, may be inserted into thebladder through the viewing unit and inflated within the bladder toretain the catheter. If later observation of the interior of the bladderis desired, the

catheter may be removed, and a telescope inserted through the viewingunit.

Yet another object is to provide the viewing unit at its proximal endwith sealing means for providing a fluid tight seal 5 around a catheter,or other device extending through the viewing unit into the bladder.

Another important object of the invention is to provide a technique oflocating and making the suprapubic incision, and of inserting thetubular viewing unit, which is substantially the same as the techniquedisclosed and claimed in my aforementioned copending application.

More particularly, an important object in this connection is to employan instrument which may be inserted through the urethra into the bladderand which is provided with a curved distal portion terminating in adistal end engageable with the anterior wall of the bladder with a lightpressure to cause the overlying abdominal wall in the suprapubic area toprotrude slightly, thereby positively locating the point at which thedesired suprapubic incision should be made so as to avoid the riskinherent in making a blind puncture.

A further object of the invention is to provide the incision locatinginstrument with a longitudinal passage extending from its proximal endto a point adjacent but spaced from its distal end and terminating inone or more lateral openings. With this construction, a fluid, such aswater, may be introduced into the bladder through the passage and thelateral openings in the instrument to inflate the bladder prior tolocating and making the suprapubic incision.

Still another important object of the invention is to provide the distalend of the incision locating instrument and the distal end of thetubular viewing unit with means for interconnecting them in any suitablemanner, with the distal end of the instru ment projecting outwardlythrough the incision, so that the instrument can be used to guide theviewing unit into the bladder through the incision, which is animportant feature. Subsequently, the incision locating andviewing-unit-inserting instrument is disconnected from the viewing unitwithin the bladder, and is withdrawn through the urethra, leaving theviewing unit in place, which is another important feature. In thisconnection, any of the instruments disclosed in my aforementionedcopending application Ser. No. 27,727 may be used.

An additional object is to provide a tubular viewing unit and a locatingand insertion instrument the distal ends of which are telescopicallyconnectible so that they can be connected quickly and easily externallyof the body when the distal end of the instrument projects through theincision, and which can be disconnected readily within the bladder afterthe instrument has been used to insert the viewing unit.

Yet another object is to provide a construction wherein the distal endof the instrument is telescopically insertable into the distal end ofthe viewing unit.

A further object is to provide a viewing unit and insertion instrumentcombination wherein the distal end of the viewing unit is telescopicallyinsertable into the distal end of the instrument. In this case, thedistal end of the instrument is tubular and may be provided with aremovable tapered closure or tip which can be removed, after outwardpassage through the incision, to admit the distal end of the viewingunit into the distal end of the instrument. Alternatively, the distalend of the instrument may comprise simply an open socket capable ofreceiving the distal end of the viewing unit.

Yet another important object of the invention is to provide a tubularviewing unit the proximal end of which is adapted to accomodate afitting through which the telescope extends and which is provided with astop cock, or the like, for admitting fluid into the bladder through anannulus between the telescope and the viewing unit, if such fluid isdesired during observation of the interior of the bladder.

The foregoing objects, advantages, features and results of i the presentinvention, together with various other objects, advantages, features andresults thereof which will be evident to those skilled in the art in thelight of this disclosure, may be achieved with the exemplary embodimentof the invention illustrated in the accompanying drawings and describedin detail hereinafter.

DESCRIPTION OF DRAWINGS In the drawings:

FIGS. 1 to 5 are fragmentary sectional views illustratingsemidiagrammatically successive steps involved in the method of theinvention of'locating and making an incision through the suprapubicregion of a patients abdominal wall and the anterior wall of thebladder, and of inserting a tubular viewing unit into the bladderthrough the incision;

FIGS. 6 and 7 are views similar to FIGS. 1 to 5, but illustrate thetechnique of the invention of fitting a telescope collar to the viewingunit and of inserting a telescope through the collar and the viewingunit;

FIG. 8 is a view similar to FIG. 6, but showing the telescope collarremoved and showing the viewing unit sutured in place;

FIG. 9 is a view similar to FIG. 8, but showing a retention catheterinserted through the viewing unit into the bladder;

FIG. 10 is an enlarged, fragmentary sectional view of the distal end ofan instrument for locating the incision and for inserting the viewingunit;

FIG. 11 is an enlarged isometric view showing one embodiment of theviewing unit in longitudinal section;

FIGS. 12 and 13 are fragmentary longitudinal sectional views of theproximal end of a tubular viewing unit of the invention equipped withalternative sealing means embodiments for maintaining a fluid tight sealwith a retention catheter, for example;

FIG. 14 is a fragmentary isometric view of a combination viewing unitand insertion instrument of the invention wherein the distal end of theviewing unit is telescoped over the distal end of the insertioninstrument with a closure tip of the insertion instrument removed;

FIG. 15 is a view similar to FIG. 14, but showing an insertioninstrument having a different distal end.

DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS OF INVENTION Referringinitially to FIGS. 1 and 10 of the drawings, illustrated therein is aninstrument which, as will be described, is used to locate a suprapubicincision and to insert a viewing unit 22, FIG. 11, therethrough. Theinstrument 20 comprises simply a rigid tube 24, of metal, plastic, orother suitable I material, having a proximal end 26, a straight orsubstantially straight intermediate portion 28, and a curved distalportion terminating in a distal end 32. The tube 24 is permanentlyclosed adjacent its distal end 32 by a partition 34 which divides theinterior of the tube into a socket 36 at its distal end and alongitudinal passage 38 extending from the partition to the proximal end26 of the tube. The tube 24 is provided at the distal end of the passage38 with one or more lateral openings 40. The socket 36 has telescopedthereinto a removable closure tip 42 which is externally tapered androunded so that it may act as an obturator facilitating insertionthrough a patients urethra as will be described hereinafter. In theconstruction illustrated, the removable tip 42 is shown simply aspressed into the socket 36. However, it may be threaded thereinto, orotherwise secured to the distal end 32 of the instrument 20. Also, thedistal end of the instrument 20 may be equipped instead with any of thetips disclosed in my aforementioned copending application Ser. No.26,727.

In the particular construction illustrated, the instrument 20 is of adiameter and a length suitable for use with female patients. However, itmay be used with male patients by suitably modifying its length,diameter and curvature.

Considering the technique of the invention with which the instrument 20is used, the tip 42 at the distal end 32 of the instrument is firstinserted through the urethra 46 of a patient 48 into the patientsbladder 50, as illustrated in FIG. 1 of the drawings. Then, a suitablefluid, such as water, is introduced into the bladder 50 through thepassage 38 and the lateral openings 40, in a quantity sufficient toinflate or distend the bladder, as shown throughout FIGS. 1 to 9 of thedrawings. This may be accomplished readily by connecting a fluid source52 to the proximal end 26 of the tube 24 by means of an elastomeric tube54 equipped with a clamp 56. As will be apparent, fluid for distendingthe bladder 50 may be introduced by disengaging the clamp 56. When thebladder has been inflated to the proper degree, the clamp 56 isre-engaged with the elastomeric tube 54 to prevent further fluidintroduction and to prevent reversed flow. It will be apparent that, inthe foregoing operations, the instrument 20 functions as an urethralcatheter.

Turning to FIG. 2, the next step is to bring the tip 42 of theinstrument 20 into engagement with the anterior wall of the bladder withsufficient force to provide a visible external protrusion 60 in thesuprapubic region 62 of the abdominal wall 64. This can be accomplishedreadily by suitable manipulation of the instrument 20 from adjacent itsproximal end 26,

The visible external protrusion 60 produced by the foregoingmanipulations locates the tip 42 of the instrument very accurately.Next, the physician, utilizing a scalpel 66, or other appropriatecutting instrument, makes a small incision 68, at

the center of the protrusion 60, through the abdominal wall 64 and theanterior wall of the bladder 50. Normally, this incision need not bemore than of the order of a few millimeters in length. I

The incision 68, which is shown in FIGS. 3 to 9 of the drawings, is madewhile maintaining the tip 42 of the instrument 20 in pressuralengagement with the anterior bladder wall. Consequently, when theincision 68 is sufficiently large, the tip 42 of the instrument 20 isautomatically displaced outwardly through the incision. In practice, thetip 42 pops through the incision 68 automatically as soon as theincision is large enough. Thus, the instrument 20 acts as a trocar inperforming this function.

In the embodiment of the invention presently under consideration, oncethe tip 42 of the instrument 20 has emerged through the incision 68, thetip 42 is removed, as shown in FIG. 3 of the drawings.'I-Iowever, withvarious of the instrument tips disclosed in my copending applicationSer. No. 26,727, this is not necessary.

Next, as shown in FIG. 4, a reduced-diameter distal end 72 of theviewing unit 22, which is tubular, is inserted into in this particularembodiment the socket 36 in the distal end 32 of the instrument 20.Thus, the distal end 72 of the viewing unit 22 and the distal end 32 ofthe instrument 20 are telescopically connectible by insertion of thedistal end 72 into the distal end 32.

As soon as the foregoing telescopic connection between the distal ends32 and 72 of instrument 20 and the viewing unit 22 has been madeexternally of the body of the patient 48, the distal and intermediateportions of the viewing unit 22 are inserted through the incision 68into the bladder 50, as shown in FIG. 5 of the drawings. It will beunderstood that such movement of the instrument and viewing unitcombination may readily be carried out by concurrent movement of thephysicians hands. In effect, the instrument and viewing unit combination20 and 22 is threaded through the patients body by the physician, withone had on the instrument 20 and the other on the proximal end of theviewing unit 22. Thus, the inztzrument 20 serves as an insertion guidefor the viewing unit Insertion of the viewing unit 22 through theincision 68 into the bladder 50 is limited by engagement of an externalannular flange 74 on the proximal end of the viewing unit with theexterior of the patients abdominal wall 64.

The next step is to disconnect the distal end 32 of the instrument 20from the distal end 72 of the viewing unit 22, and to withdraw theinstrument 20 from the bladder 50 and the urethra 46. The distal ends 32and 72 of the instrument and the viewing unit 22 are only lightlyengaged by the telescopic connection therebetween so that they can bedisconnected within the bladder 50 readily by a slight pull on theinstrument The interior of the tubular viewing unit 22 comprises a bore80 adjacent the distal end of the viewing unit and a counterbore 82extending from the bore 80 to the proximal end of the viewing unit. Thediameter of the counterbore 82 is such as to pennit telescopic insertionof a stop cock fitting 84, as shown in F IG. 6 of the drawings. Thefitting 84 may be equipped with a stop cock 86, or the like, to which asource of fluid, such as water, may be connected if it is desired tointroduce fluid into the bladder 50 at this stage, or during thesubsequent viewing stage to be described.

As shown in FIG. 7, the next step in the technique of the invention isto insert a conventional telescope 88 through the fitting 84 and theviewing unit 22 into the bladder 50, the telescope making a sliding fitin the bore 80 at the distal end of the viewing unit. As will beapparent, with the telescope 80 installed as described, the physicianmay quickly and easily view the entire interior of the bladder 50. Ifdesired, photographs may be taken through the telescope 88, or with analternative telescope, not shown, substituted for the telescope 88.

After viewing of the interior of the bladder 50 in the manner described,the physician may decide to leave the tubular viewing unit 22 in placeto permit viewing the bladder again at a later time. In this case, theviewing unit 22 may be secured in place by sutures 90, FIG. 8, extendingthrough openings 92, FIG. 11, in the annular flange 74 and throughadjacent portions of the patients abdominal wall 64. The proximal end ofthe counterbore 82 may be closed by means of any suitable closure, notshown, to prevent urine leakage. It will be understood that the edges ofthe incision 68 grip the exterior of the viewing unit 22 suflicientlytightly to prevent urine leakage around the viewing unit.

Alternatively, if the use of a catheter is indicated, a suitableretention catheter, such as a Foley catheter 94, may be inserted intothe bladder 50 through the tubular viewing unit 22, as shown in FIG. 9.As is conventional, the catheter 94 is provided with a portion 96 whichmay be inflated with air, or other gas, to retain the tip 98 of thecatheter within the bladder 50. The catheter may be inserted with theassistance of a catheter probe, as is well known and as is disclosed inmy aforementioned copending application.

To prevent urine leakage between the catheter 94 and the viewing unit22, the proximal end of the viewing unit 22 is equipped with a sealingmeans 102, FIG. 12, or 104, FIG. 13, for providing a fluid tight sealbetween the catheter and the viewing unit. The sealing means 102 of FIG.12 is simply an elastomeric plug pressed into the proximal end of thecounterbore 82 and provided with a passage 106 of a size to accommodateand make a fluid tight seal with the catheter 94. The sealing means 104of FIG. 13 is shown simply as comprising an elastomeric membrane fittingover the annular flange 74 of the viewing unit 22 and provided with anaperture 108 to receive and seal with the catheter.

In the embodiments of the invention thus far described, the combinationof the insertion instrument 20 and the viewing unit 22 includes atelescopic connection for the distal ends 32 and 72 thereof whichrequires insertion of the distal end 72 of the viewing unit into thedistal end 32 of the insertion instrument. This telescopic connectionmay be reversed by providing for insertion of the distal end 32 of theinstrument 20 into the distal end of the viewing unit, as shown in FIGS.14 and 15, and as will now be described.

The viewing unit shown in FIGS. 14 and 15 is quite similar to theviewing unit 22 and is designated generally by the numeral 122. It isprovided therein with a counterbore 182 corresponding to the counterbore82, and terminates at its proximal end in an external annular flange 174corresponding to the flange 74 and equipped with suture openings 192.The principal difference is that the viewing unit 122 terminates at itsdistal end in a tapered, and preferably elastomeric, tip 200 of a sizeto receive therein the distal end 32 of the instrument in telescopicsliding relation. As shown in FIG. 14, the

viewing unit tip 200 may be telescoped over the distal end 32 of theinstrument 20 with the tip 42 of the latter removed, although the tip 42may be left in place also. Alternatively, as shown in FIG. 15, thedistal end 32 of the instrument 20 may be open and have a slanted endface 204 and may be inserted into the tip 200 of the viewing unit 122without removing any closure. As still other alternatives, the viewingunit tip may be telescoped into or over'any of the instrument tips of myapplication Ser. No. 26,727. In all other respects, the combination ofthe instrument 20 and the viewing unit 122 operates in the same manneras the combination of the instrument 20 and the viewing unit 22.

Although exemplary embodiments of the present invention have beendisclosed for purposes of illustration, it will be understood thatvarious changes, modifications and substitutions may be incorporated insuch embodiments without departing from the scope of the invention asdefined by the claimsappearing in the next section of thisspecification.

I claim as my invention:

1. A method of inserting a portion of a viewing unit into a body cavity,such as a hollow internal organ, through an incision in the wall of thecavity and the overlying part of the body, the interior of the cavitycommunicating with the exterior of the body through a body opening, saidmethod being characterized by the use of an instrument having a distalend, and including the steps of:

a. inserting the distal end of the instrument through the body openinginto the interior of the cavity and into engagement with the wall of thecavity in register with the desired area of the exterior of the body;

b. making an incision through the overlying part of the body and thewall of the cavity in register with the distal end of the instrument;

c. displacing the distal end of the instrument outwardly through theincision;

d. connecting a portion of the viewing unit to the distal end of theinstrument;

e. displacing the distal end of the instrument and a portion of theviewing unit into the interior of the cavity through the incision;

f. disengaging the distal end of the instrument from the viewing unitwithin the cavity; and

g. withdrawing the instrument from the cavity and the body opening,leaving a portion of the viewing unit within the cavity.

2. A method of inserting a portion of a viewing unit into the bladder,characterized by the use of an instrument having a curved distal portionterminating in a distal end, and including the steps of:

a. inserting the distal end of the instrument through the urethra intothe bladder and into engagement with the anterior wall of the bladder inregister with the suprapubic area of the abdominal wall;

b. making an incision through the abdominal wall and the anterior wallof the bladder in register with the distal end of the instrument;

c. displacing the distal end of the instrument outwardly through theincision; connecting a portion of the viewing unit to the distal end ofthe instrument;

e. displacing the distal end of the instrument and a portion of theviewing unit into the bladder through the incision; and

f. withdrawing the instrument from the bladder and the urethra, leavinga portion of the viewing unit within the bladder.

3. A method as set forth in claim 2 characterized by the use of aviewing unit which is tubular, and including the additional step ofinserting a telescope through the viewing unit into the bladder.

4. A method according to claim 3 including the further step of suturingthe viewing unit to the suprapubic area of the abdominal wall.

5. A method as defined in claim 2 characterized by the use of a viewingunit which is tubular, and including the additional step of inserting aretention catheter through the viewing unit into the bladder.

6. A method as set forth in claim 5 including the further step 5 ofsuturing the viewing unit to the suprapubic area of the abdominal wall.

j 2%? 4 UNITED-STATES PATENT OFFICE -CERTIFICATE OF CORRECTION PatentNO- t I I Dated Inventor-(s) D: ,Iggg B BpbertS on v It is certifiedthat error 'appeare 1n the above-identified patent and that .saidLetters Patent are hereby corrected as shown below:

' Abs-tract, line 26 after "Subsequently" insert --the distal end of theinsertion instrument is disconnected from-- Co1umn'2, line 4 2, SerialNo. 27,727" should be "Serial No. 26,727"

Signed and sealed this zuth day of October 1972.

(SEAL) Attest:

EbWAHD M.FLETCHER,JR. ROBERT GUTTSCHALK Commissioner of PatentsAttesting Officer

1. A method of inserting a portion of a viewing unit into a body cavity,such as a hollow internal organ, through an incision in the wall of thecavity and the overlying part of the body, the interior of the cavitycommunicating with the exterior of the body through a body opening, saidmethod being characterized by the use of an instrument having a distalend, and including the steps of: a. inserting the distal end of theinstrument through the body opening into the interior of the cavity andinto engagement with the wall of the cavity in register with the desiredarea of the exterior of the body; b. making an incision through theoverlying part of the body and the wall of the cavity in register withthe distal end of the instrument; c. displacing the distal end of theinstrument outwardly through the incision; d. connecting a portion ofthe viewing unit to the distal end of the instrument; e. displacing thedistal end of the instrument and a portion of the viewing unit into theinterior of the cavity through the incision; f. disengaging the distalend of the instrument from the viewing unit within the cavity; and g.withdrawing the instrument from the cavity and the body opening, leavinga portion of the viewing unit within the cavity.
 2. A method ofinserting a portion of a viewing unit into the bladder, characterized bythe use of an instrument having a curved distal portion terminating in adistal end, and including the steps of: a. inserting the distal end ofthe instrument through the urethra into the bladder and into engagementwith the anterior wall of the bladder in register with the suprapubicarea of the abdominal wall; b. making an incision through the abdominalwall and the anterior wall of the bladder in register with the distalend of the instrument; c. displacing the distal end of the instrumentoutwardly through the incision; d. connecting a portion of the viewingunit to the distal end of the instrument; e. displacing the distal endof the instrument and a portion of the viewing unit into the bladderthrough the incision; and f. withdrawing the instrument from the bladderand the urethra, leaving a portion of the viewing unit within thebladder.
 3. A method as set forth in claim 2 characterized by the use ofa viewing unit which is tubular, and including the additional step ofinserting a telescope through the viewing unit into the bladder.
 4. Amethod according to claim 3 including the further step of suturing theviewing unit to the suprapubic area of the abdominal wall.
 5. A methodas defined in claim 2 characterized by the use of a viewing unit whichis tubular, and including the additional step of inserting a retentioncatheter through the viewing unit into the bladder.
 6. A method as setforth in claim 5 including the further step of suturing the viewing unitto the suprapubic area of the abdominal wall.